[Modification of specialised care prescriptions by Primary Healthcare physicians]. / Modificación de la prescripción procedente del segundo nivel de asistencia por parte del médico de Atención Primaria.

OBJECTIVE: To determine the percentage of new Specialist Healthcare prescriptions received and modified by Primary Healthcare physicians. DESIGN: Descriptive, cross-sectional and multi-centre study with the participation of Primary Healthcare physicians from one Madrid Health Area during 2 months. A method was established for registering the origin of the new prescriptions in the Computerised Medical Record System. In order to register new prescriptions without any change from Specialist Healthcare, the «second level¼ option was marked when the prescription was issued. A protocol was prepared and was available on the Computerized Medical Record System, so for those cases where there was a new Specialist Healthcare prescription, the Primary Healthcare physician would not issue any prescription or issue a prescription with changes as regards the original one. RESULTS: A total of 69 Primary Healthcare physicians from 15 Primary Healthcare centres registered 46,512 new prescriptions, 3,893 (8.4%) from Specialist Healthcare. From this number, 3,544 prescriptions (91.0% 95% CI: 90.1-91.9) were issued without changes, and 298 prescriptions were modified (7.7% 95% CI: 7.0-8.7). In 46 cases (1.2% 95% CI: 0.8-1.5) no prescription was issued. Some prescriptions were changed by 51% of Primary Healthcare physicians, and the median of prescriptions changed or not issued was 3. The main reason for the modification was replacement with generics. CONCLUSIONS: A high percentage of new Specialist Healthcare prescriptions are issued without any changes being made by Primary Healthcare physicians. Modifications are concentrated in half of the participating physicians. Therefore, these data suggest that this practice is not generally adopted by the professionals.

[Intervention of a pharmacy department following the 11-M terrorist attack]. / Actuación de un servicio de farmacia en el atentado terrorista del 11-M.

OBJECTIVE: To describe the intervention of a pharmacy department, as well as medication requirements, in the healthcare emergency situation brought about by the terrorist attack of March 11, 2004 in Madrid. To compare this intervention with other similar experiences reported in the medical literature. METHOD: A compilation of actions carried out by pharmacists directly involved in the management of this incident. A literature search of Medline, Cochrane Library, and Spanish Index Medicus databases. RESULTS: The pharmacy department acted to ensure the availability of all medication needed in the management of casualties by placing urgent orders in pharmaceutical laboratories, simplifying distribution networks, and staying in permanent contact with the medical and nursing staff of the emergency department, as well as with people in charge of emergency coordination. Most commonly used medications included plasma expanders, fluid therapy, blood-derived products, pain killers, antiseptics, peripheral myorelaxants, and antibiotics, which are consistent with those employed by other Madrid hospitals for this same attack. CONCLUSIONS: The pharmacy department, as any other department in a hospital, should be ready to rapidly and effectively cope with any emergency situation. Having a protocol available including major intervention guidelines is advisable to reduce reaction times, anticipate potential complications, and effectively solve such situations.